Impact and challenges of hearing loss following meningitis

Vicki Kirwin

After Meningitis Conference, London November 2009

Meningitis and hearing loss

• Biggest cause of acquired sensorineural hearing impairment in children (~6% all PCHI)

• Majority of children are deafened before their 3rd birthday

• Bilateral or unilateral • Any level from mild to profound hearing loss• Hearing loss normally occurs early in the

course of the illness • Hearing loss often not immediately stable

Meningitis causes hearing loss…

•Most commonly as result of infection spreading into the cochlea

• Sometimes due to inflammation of the auditory nerve

•Can also affect the vestibular organ

•Ossification

Protocol for early referral - newborn babiesNewborn babies who have had bacterial

meningitis are excluded from the newborn

hearing screen and ref’d for full audiological

assessment

1/10 following meningitis 1/100 NICU/SCBU babies 1/1000 for well babies

Protocol for early referral - older infants and children

"Immediate referral to Audiology for age-appropriateassessment If these conditions occur at any point ininfancy or childhood after the screen then, on recovery,immediate referral should be made to Audiology for anage-appropriate audiological assessment within 4 weeks of discharge from hospital”

Guidelines for surveillance and audiological monitoring of infants & children following the newborn hearing screen (NHSP Clinical Group, 2009) http://hearing.screening.nhs.uk/cms.php?folder=88

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AUDIOGRAM OF FAMILIAR SOUNDSFREQUENCY IN CYCLES PER SECOND (HZ)

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0

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40

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60

70

80

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110

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125 250 500 1000 2000 4000 8000

HE

AR

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L (

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Impact of hearing loss

• Pre-lingually deafened

• Post-lingually deafened

• Degree of deafness

Impact of hearing loss

• Home

• Education

• Social

Impact of hearing loss pre-lingually deafened• Language acquisition and use• Speech and communication• Incidental hearing for learning• Child’s behaviour may have changed• Attention span may be shorter• Temper tantrums • More clingy• Siblings may react to the focus of attention on

the deaf child

Impact of hearing loss post-lingually deafened

• Maintaining speech and language skills• Emotional impact of illness• Emotional impact and acceptance of hearing

loss• Support needed to find new ways of

communicating• Incidental hearing for learning & gossip!

Impact of hearing loss post-lingually deafened

• Different experiences to peers• Unwanted/higher levels adult

direction/attention• Professional intervention - ToD, SLT, support

assistants, social worker, Ed. Psychologist, audiologist, GP, consultant, etc

• Higher risk mental health problems

Management of the hearing loss - hearing aids

Sound enters the

microphone, is processed

and amplified and exits

via the receiver. The

amplified sound enters

the ear via the tubing and

ear mould.

Management of the hearing loss - cochlear implants

A surgically implanted electronic device which stimulates the hearing nerves in thecochlea directly.

Cochlear implants cont.

Sound enters the microphone. The sound is transformed into electrical signals and transfers across the skin from the receiver to the internal electrodes. The electronic signals are ‘de-coded’ by the brain and ‘heard’.

Management of the hearing loss - other support

• voice to text software for computers• subtitles on television, DVDs, cinemas and

theatres• note takers and communication support

workers in school• text phones that give access to phone calls• lip-reading • sign language

NDCS support

• Founded by parents for parents in 1944

• The UK’s largest national charity supporting all deaf children and their families

• Supports all families regardless of deafness, amplification, communication methodology and educational placement.

NDCS objectives

• Offer clear, balanced information and support to families

• Advocate for deaf children, young people and their families

• Providing opportunities for young deaf people to develop social skills, confidence and independence

• Work with professionals and policy makers to ensure high quality services are available for all

• Campaign and lobby on issues affecting the lives of deaf children, young people and their families

NDCS services

• Freephone helpline 0808 800 8880• Free membership to families and professionals• Family officers• Legal casework team• Regional directors team• Offices in London, Birmingham, Belfast, Cardiff and Glasgow• Membership magazine & email updates• Free publications • A purpose built listening bus • An equipment loan scheme • Grants to help parents on low incomes buy computers• Local DCS’s• Events for families and young deaf people including arts, sports, outdoor

activities and family weekends

Further references & resources• Balance and balance disorders factsheet, NDCS, 2008. www.ndcs.org.uk• Fortnum HM & Davis AC (1993). Hearing impairment in children after bacterial

meningitis: incidence and resource implications. Brit J Audiol 27, 43-52 • Fortnum HM, Summerfield AQ, Marshall DH, Davis AC, Bamford JM (2001).

Prevalence of permanent childhood hearing impairment in the United Kingdom and implications for universal neonatal hearing screening: questionnaire based ascertainment study. Brit Med J 323(7312), 536-40

• Guidelines for surveillance and audiological monitoring of infants & children following the newborn hearing screen, NHSP, July 2009 http://hearing.screening.nhs.uk/cms.php?folder=88

• Meningitis and childhood deafness, NDCS/The Meningitis Trust, 2009 www.ndcs.org.uk

• Meningitis & Hearing Loss (Deafness Research UK, 2005)

http://www.deafnessresearch.org.uk/Factsheets+3565.twl • http://www.nhs.uk/Conditions/Meningitis/Pages/Introduction.aspx

vicki.kirwin@ndcs.org.ukwww.ndcs.org.uk